Download PDF
Klin Monbl Augenheilkd 2013; 230(8): 820-824
DOI: 10.1055/s-0032-1328773
Klinische Studie
Georg Thieme Verlag KG Stuttgart · New York

Sehbehinderung und Blindheit bei Kindern in einer malawischen Blindenschule

Visual Impairment and Blindness in Children in a Malawian School for the Blind
M. Schulze Schwering
1   Augenheilkunde, Universitätsaugenklinik Tübingen
3   Ophthalmology, College of Medicine, University of Malawi, Blantyre, Malawi
,
M. Nyrenda
2   Ophthalmology, Blantyre Institute of Community Ophthalmology (BICO), Blantyre, Malawi
,
M. S. Spitzer
1   Augenheilkunde, Universitätsaugenklinik Tübingen
3   Ophthalmology, College of Medicine, University of Malawi, Blantyre, Malawi
,
K. Kalua
2   Ophthalmology, Blantyre Institute of Community Ophthalmology (BICO), Blantyre, Malawi
3   Ophthalmology, College of Medicine, University of Malawi, Blantyre, Malawi
› Author Affiliations
Further Information

Publication History

eingereicht 07 February 2013

akzeptiert 13 June 2013

Publication Date:
19 August 2013 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Hintergrund: Bestimmung der anatomischen Klassifikation der häufigsten Gründe für eine Sehbehinderung oder Blindheit von Kindern, die eine integrierte Blindenschule in Malawi besuchen. Vergleich der erhobenen Daten mit älteren malawischen Blindenschulstudien.

Methode: Im September 2011 wurden Kinder der integrierten Gesamtschule für Blinde an einem Tag direkt vor Ort untersucht. Verwendet wurde das Standardprotokoll der WHO zur Untersuchung von Blinden und Sehbehinderten. Der Visus des jeweils besseren Auges wurde in diesem WHO-Protokoll notiert.

Ergebnisse: 55 Kinder zwischen 6 und 19 Jahren wurden untersucht. 39 (71 %) Jungen und 16 (29 %) Mädchen. 38 (69%) waren blind [BL], 8 (15 %) stark sehbehindert [SVI], 8 (15 %) sehbehindert [VI], und ein Kind (1,8 %) hatte keine Sehbehinderung [NVI]. Die häufigsten Erblindungsursachen nach anatomischer Klassifikation waren der Sehnerv (16 %) und die Netzhaut (16 %), gefolgt von Linse (15 %), Hornhaut (11 %) und Erkrankungen des Bulbus (11 %), Pathologien der Uvea (6 %) und kortikale Blindheit (2 %). Die exakte Ätiologie von Blindheit und Sehbehinderung konnten bei den meisten Kindern nicht bestimmt werden. Albinismus zählte mit 13 % (7/55) zu den häufigsten Ursachen einer Sehbehinderung. 24 % der Ursachen wären vermeidbar gewesen: refraktive Schwachsichtigkeit bei Pseudophakie-Patienten und Hornhautnarben.

Schlussfolgerung: Optikusatrophie, retinale Erkrankungen (zumeist Albinismus) und Katarakte sind die Haupterblindungsursachen in einer integrierten Blindenschule in Malawi. Eine Erblindung infolge von Hornhautnarben wurde als vierthäufigster Grund festgestellt, 35 Jahre zuvor war dies der häufigste Grund. Die kongenitale Katarakt bzw. ihre postoperativen Folgen sind der häufigste vermeidbare Grund einer Sehbehinderung oder Erblindung.

Abstract

Purpose: The aim of this study was to determine the anatomic sites of severe visual impairment and blindness in children in an integrated school for the blind in Malawi, and to compare the results with those of previous Malawian blind school studies.

Methods: Children attending an integrated school for the blind in Malawi were examined in September 2011 using the standard WHO/PBL eye examination record for children with blindness and low vision. Visual acuity [VA] of the better eye was classified using the standardised WHO reporting form.

Results: Fifty-five pupils aged 6 to 19 years were examined, 39 (71 %) males, and 16 (29 %) females. Thirty eight (69%) were blind [BL], 8 (15 %) were severely visually impaired [SVI], 8 (15 %) visually impaired [VI], and 1 (1.8 %) was not visually impaired [NVI]. The major anatomic sites of visual loss were optic nerve (16 %) and retina (16 %), followed by lens/cataract (15 %), cornea (11 %) and lesions of the whole globe (11 %), uveal pathologies (6 %) and cortical blindness (2 %). The exact aetiology of VI or BL could not be determined in most children. Albinism accounted for 13 % (7/55) of the visual impairments. 24 % of the cases were considered to be potentially avoidable: refractive amblyopia among pseudophakic patients and corneal scaring.

Conclusions: Optic atrophy, retinal diseases (mostly albinism) and cataracts were the major causes of severe visual impairment and blindness in children in an integrated school for the blind in Malawi. Corneal scarring was now the fourth cause of visual impairment, compared to being the commonest cause 35 years ago. Congenital cataract and its postoperative outcome were the commonest remedial causes of visual impairment.

Schlüsselwörter

Katarakt - Kinderophthalmologie - Hornhaut - Blindenschule - Malawi - Afrika

Key words

cataract - paediatric ophthalmology - cornea - school for the blind - Malawi - Africa
 

  • Literatur

  • 1 World Health Organization. Global initiative for the elimination of avoidable blindness. 1996; WHO/PBL/97.61. Geneva: World Health Organization; 1997
    CrossrefGoogle Scholar
  • 2 Gilbert C, Foster A. Childhood blindness in the context of VISION 2020 – the right to sight. Bull World Health Organ 2001; 79: 227-232
    PubMedGoogle Scholar
  • 3 Chandna A, Gilbert C. When your eye patient is a child. Community Eye Health 2010; 23: 1-3
    PubMedGoogle Scholar
  • 4 Schulze Schwering M, Batumba HN. Weiterbildung zum Facharzt für Augenheilkunde: Kann das deutsche vom Malawischen System lernen?. Klin Monatsbl Augenheilkd 2013; 230: 72-75
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Gogate P, Kalua K, Courtright P. Blindness in childhood in developing countries: time for a reassessment?. PLoS Med 2009; 6: e1000177
    CrossrefPubMedGoogle Scholar
  • 6 Chirambo M, Benezra D. Causes of blindness among students in blind school institutions in a developing country. Br J Ophthalmology 1976; 60: 665-668
    CrossrefPubMedGoogle Scholar
  • 7 Foster A, Sommer A. Corneal ulceration, measles and childhood blindness from Tanzania. Br J Ophthalmology 1987; 71: 331-343
    CrossrefPubMedGoogle Scholar
  • 8 Gilbert CE, Wood M, Waddel K et al. Causes of childhood blindness in East Africa: Results in 491 pupils attending 17 schools for the blind in Malawi, Kenya and Uganda. Ophthalmic Epidemiol 1995; 2: 77-84
    CrossrefPubMedGoogle Scholar
  • 9 Gilbert C, Foster A, Négrel AD et al. Childhood blindness: a new form for recording causes of visual loss in children. Bull World Health Organ 1993; 71: 485-489
    PubMedGoogle Scholar
  • 10 Chirambo MC, Tielsch JM, West jr. KP et al. Blindness and visual impairment in Southern Malawi. Bull World Health Organ 1986; 64: 567-572
    PubMedGoogle Scholar
  • 11 Njuguna M, Msukwa G Shilio Bet al. Causes of severe visual impairment and blindness in children in schools for the blind in eastern Africa: changes in the last 14 years. Ophthalmic Epidemiol 2009; 16: 151-155
    CrossrefPubMedGoogle Scholar
  • 12 Cohen N, Measham C, Khanum S et al. Xerophthalmia in urban Bangladesh. Implications for vitamin A deficiency preventive strategies. Acta Paediatr Scand 1983; 72: 531-536
    CrossrefPubMedGoogle Scholar
  • 13 Gilbert C, Muhit M. Twenty years of childhood blindness: what have we learnt?. Community Eye Health 2008; 21: 46-47
    PubMedGoogle Scholar
  • 14 Courtright P, Lewallen S, Kanjaloti S. Changing patterns of corneal disease and associated vison loss at a rural African hospital following a training programme for traditional healers. Br J Ophthalmology 1996; 80: 694-697
    CrossrefPubMedGoogle Scholar
  • 15 Tumwesigye C, Msukwa G, Njuguna M et al. Inappropriate enrollment of children in schools for the visually impaired in east Africa. Ann Trop Paediatr 2009; 29: 135-139
    CrossrefPubMedGoogle Scholar
  • 16 Schulze Schwering M, Msukwa G, Spitzer MS et al. Pediatric cataract surgery in Malawi. Ophthalmologe epub ahead of print June 15, 2013
    PubMedGoogle Scholar
  • 17 Gogate P, Gilbert C, Zin A. Severe visual impairment and blindness in infants: causes and opportunities for control. Middle East Afr J Ophthalmol 2011; 18: 109-114
    CrossrefPubMedGoogle Scholar
  • 18 Gilbert C, Fielder A, Gordillo L et al. International NO-ROP Group. Characteristics of babies with severe retinopathy of prematurity in countries with low, moderate and high levels of development: Implications for screening programmes 2005; 115: e518-e525
    PubMedGoogle Scholar
  • 19 Kello AB, Gilbert C. Causes of severe visual impairment and blindness in children in schools for the blind in Ethiopia. Br J Ophthalmol 2003; 87: 526-530
    CrossrefPubMedGoogle Scholar
  • 20 Knappe S, Schittkowski M, Schröder W et al. Die gegenwärtig häufigsten Ursachen der Kinderblindheit in Kinshasa (D.C. Kongo). Klin Monatsbl Augenheilkd 2007; 224: 597-602
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Noche CD, Bella AL. [Frequency and causes of blindness and visual impairment in schools for the blind in Yaoundé (Cameroon)]. Santé 2010; 20: 133-138
    PubMedGoogle Scholar
  • 22 Alagaratnam J, Sharma TK, Lim CS et al. A survey of visual impairment in children attending the Royal Blind School, Edinburgh using the WHO childhood visual impairment database. Eye 2002; 16: 557-561
    CrossrefPubMedGoogle Scholar
  • 23 Kalua K. Use of key informants in determining the magnitude and causes of childhood blindness in Chikwawa district, southern Malawi. Community Eye Health 2007; 20: 8
    PubMedGoogle Scholar
  • 24 Kalua K, Ngʼongola RT, Mbewe F et al. Using primary health care (PHC) workers and key informants for community based detection of blindness in children in Southern Malawi. Hum Resour Health 2012; 10: 37
    CrossrefPubMedGoogle Scholar
  • 25 Schulze Schwering M. Globale Blindheit. Ophthalmologe 2007; 10: 845-848
    PubMedGoogle Scholar